Aging in Oregon

AGING IN OREGONUnderstanding Long Term Care Services for Older Adults Module 3 - Finance

Financing Long Term Care In Oregon, approximately two-thirds of

the cost of long-term care is paid for privately, and not through insurance or public support (Medicaid). Medicare does not over the cost of most long-term care.

Oregon is unique in that Medicaid payments include a full array of community-based care services (e.g., adult foster care, in-home care, assisted living, residential care).

In Review: What is Long Term Care? A variety of services including medical

and non-medical services for people who have chronic illness and/or disability.

Usually assists people with activities of daily living (bathing, dressing, using the bathroom).

May be provided at home, in the community, in an assisted living, or a nursing home.

Click on this link for more information.

Long Term Care Services

The cost and payer source of long term care varies depending on what you need, where you receive care, and where you live.

Check out the link below for information about different types of long term care options.

Medicare.gov The official U.S. Government site for Medicare

Indicator 34 – Sources of Payment for Health Care Services

Financing Long Term Care -Medicare versus

Medicaid

Medicare Home Health Care

ordered by physician for rehab (not chronic care management, household help, IADL support)

Skilled Nursing Home care after qualified hospitalization, need for short-term skilled care or rehabilitation (not chronic care management)

Hospice Care

Medicaid Pays for services for

those with low incomes. Must have to “spend down” assets to qualify.

In Oregon and some other states, Medicaid pays for home & community-based services, as well as nursing home care.

What is Medicare?

Medicare is a health insurance program for: people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease

(permanent kidney failure requiring dialysis or a kidney transplant).

Medicare has: Part A - Hospital Insurance Part B - Medical Insurance Prescription Drug Coverage

Watch this youtube video for a quick and interesting overview about Medicare Parts A, B, C, & D.

What about Medicaid?

Oregon Health Plan - The Oregon Health Plan (OHP) offers health care to its members at little or no cost. The program covers a wide range of medical benefits and services such as doctor's visits, prescription drugs and other medically necessary services and supplies. You must have been without private health insurance for at least the last 6 months. You will not qualify for OHP if you have Medicare, unless you are pregnant. You also must meet one of the following: Be less than 19 years of age; be pregnant; or have been selected from the reservation list. Beginning in March, 2008, the state will randomly select 2,000 people per month for 12 months. 

Qualified Medicare Beneficiaries - The Qualified Medicare Beneficiaries (QMB) program helps people who have Medicare pay for their co-pays and premium 

More about Medicaid… Oregon Supplemental Income Program Medicaid -

OSIPM covers a wide range of medical benefits and services such as doctor's visits, prescription drugs and other medically necessary services and supplies. Once you are eligible for OSIPM, you may also be eligible for services such as in-home care, adult foster homes, residential care, assisted living, nursing home care and cash for special needs.

The program provides medical benefits to: People with disabilities (physical or mental disabilities). Those who are legally blind. Those older than age 65.

Check out this youtube from the Kaiser Family Foundation about Medicaid and Health Care Reform

How older adults pay for long term care (2000)

Nursing Homes (US)

Home & CBC

(US)

Private Pay 16% 41%

Medicaid 44% 18%

Medicare40% 29%

Home health/Hospice

Long-term care insurance

0.4% 0.7%

Other public payers - 10%

Medicaid Expenditures for LTC in Oregon (2005-2007 expenditures)

Expenditures % of Clients Served

Nursing Homes 33% 17%

ALFs, RCFs, AFHs

32% 40%

Home Care Workers

35% 43%

Private vs. Medicaid

If the older adult is eligible for Medicaid assistance, the local Senior and People with Disability Services (SPD)or the Area Agency on Aging (AAA)office will determine the total amount that will be paid for care.

Based on the person’s income, there will be a decision made to the amount the older adult will be asked to pay and the amount SPD will pay to provider (assisted living, residential care, adult foster home), if any.

In her own words…

Hannah describes the challenges of supporting the needs of Medicaid patients.

Please note: Allowing the YouTube clips to fully load in your browser window may result in better video quality.

Hannah Perry, BSN, RN talks about the challenges of getting Medicaid patients what they need.

In Home Care - Cost

Private Hourly

Private Caregiver: $10 – 18 per hour Agency/Company: $19 – 26 per hour

24-hr shift/live in Private Caregiver: $150 – 200 per day Agency/Company: $240 – 300 per day

Medicaid Pay-in depends on income

May be anywhere from $1 – 10 per hour

Assisted Living Facilities - Cost In 2007, a private room in an assisted living

facility averaged more than $32,000 per year in the Portland area and almost $33,000 in the rest of the state.

This cost covers room and board, basic utilities (electricity, heat, water, and garbage), basic housekeeping (fresh linens) and some meals. Many facilities include 20 to 40 meals as part of the package. These meals can be breakfast, lunch or dinner.

The cost doesn’t cover health care services – this is an additional cost based on what services the person needs.

Assisted Living - Coverage

Private vs Medicaid: Some private health and long-term care insurance policies include coverage for assisted living facilities. Medicaid can be a funding source for individuals who meet certain financial and medical criteria.

Medicare does not cover the cost of living in an assisted living facility.

Residential Care Facilities - Cost The cost of residential care for an older

adult can range from $1500 to $4,500 a month, depending on the care needs and the quality of the accommodations.

Private vs Medicaid: Medicaid can be a funding source for individuals who meet certain financial and medical criteria.

Medicare does not cover the cost of living in an assisted living facility.

Adult Foster Homes - Cost

The cost of care in an adult foster home varies based on geographic area, type of care/service the home provides, level of care the person requires, and sophistication/education of the provider.

Cost includes room, board, and care. Costs range from $2500 – 5000 per month. Medicare does not pay for adult foster

home care, neither do most long term care policies. However, Medicaid does pay for care in adult foster homes.

Memory Care Communities - Cost

In 2008, dementia care provided in an assisted living community cost $4,267 per month or $51,204 annually.

In a nursing home, dementia care averaged $219 ($79,935 annually) for a private room and $198 ($72,270) for a semi-private room.  

Medicare does not pay for care in a Memory Care Community. Medicaid will pay if person is eligible.

Nursing Facilities - Cost

In 2007, the average annual cost of a private room in a nursing home was almost $76,000 in the Portland area and almost $71,000 in the rest of Oregon.

Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services.

Nursing Facilities - Coverage About half of all nursing home residents

pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.

After qualifying for Medicaid, an individual must continue to put all income toward the cost of nursing home care, except for a small personal needs allowance.